Abstract:

Objective To investigate the efficacy and safety of dexmedetomidine with different doses combined with sufentanil on patient-controlled intravenous analgesia （PCIA） after lung cancer radical surgery. Methods Ninety patients with ASA physical status Ⅱ or Ⅲ after lung cancer radical surgery were divided into three groups （30 cases in each group）. A group （sufentanil plus low-dose dexmedetomidine 0.06 μg?kg-1?h-1）; B group（sufentanil + mid-dose dexmedetomidine 0.06 μg?kg-1?h-1）;  C group（sufentanil plus high-dose dexmedetomidine 0.06 μg?kg-1 ?h-1）. The patients in three groups were given sufentanil 0.04 μg?kg-1?h-1. The VAS pain score, Ramsay sedation score, blood pressure, heart rate, breathing were recorded at 4 h, 8 h, 12 h, 16 h, 24 h and 48 h after surgery. The PCA press times, the satisfaction of patients, the occurrence of adverse reactions such as nausea, vomiting, itching, hypotension, bradycardia, respiratory depression and sedation excessive during the postoperative analgesia were recorded. Results Compared with A group, SBP, DBP and heart rate in B group, C group in all time points decreased with statistically significant（P<0.05）. Compared with B group, SBP, DBP and heart rate in C group in all time points decreased with statistically significant （P<0.05）. The postoperative VAS scores in three groups in all time points were less than 4. Group A took the top, followed by Group B, Group C. And the differences are statistically significant（P<0.05）. Ramsay scores at 4 h, 8 h, 12 h, 16 h, 24 h, Group C took the top, followed by Group B, Group A. And the differences are statistically significant（P<0.05）. There were no significant differences in PCA press times and the PCA press effective times in three groups（P>0.05）. The incidence of adverse effects in the group A and group C were significantly higher than those of group B（P<0.05）. The satisfaction of patients in the group B was significantly higher than those of group A and group C（P<0.05）. Conclusion The application of sufentanil（0.04 μg?kg-1?h-1）combined with mid-dose dexmedetomidine（0.08 μg?kg-1?h-1）on patient-controlled intravenous analgesia after lung cancer radical surgery can effectively improve analgesia and sedative effects and reduce the adverse reactions, improve the satisfaction of patients.

Key words: sufentanil, lung cancer, dexmedetomidine, patient-control, analgesia

摘要：

目的 观察不同剂量右美托咪定联合舒芬太尼用于肺癌根治术后自控静脉镇痛（PCIA）的效果。方法 90例ASAⅡ~Ⅲ级肺癌根治术患者，分为三组，每组各30例。A组：舒芬太尼+低剂量右美托咪定（0.06μg?kg-1?h-1），B组：舒芬太尼+中剂量右美托咪定（0.08μg?kg-1?h-1），C组：舒芬太尼+高剂量右美托咪定（0.1μg?kg-1?h-1），舒芬太尼用量均为：0.04μg?kg-1?h-1。观察并记录PCIA后4h（T1）、8h（T2）、12h（T3）、16h（T4）、24h（T5）、48h（T6）的VAS评分与Ramesay评分，记录不良反应如恶心、呕吐、皮肤瘙痒、低血压、心动过缓、呼吸抑制和镇静过度等发生情况，并比较各组血压、心率、呼吸变化PCA按压次数及镇痛满意度。结果 与A组比较，B组、C组的收缩压和舒张压和心率在术后各个时间点均有不同程度的降低，差异有统计学意义（P<0.05）。与B组比较，C组的收缩压和舒张压和心率在术后各个时间点均有不同程度的降低，差异有统计学意义（P<0.05）。三组呼吸在术后各个时间点差异没有统计学意义（P>0.05）。各时间点的VAS评分均低于4分，A组最高，由高到低依次为A组、B组、C组，差异有统计学意义（P<0.05）；除外T6时间点Ramsay评分，均为A组最低，三组由低到高依次为A、B、C组，差异有统计学意义（P<0.05）。三组患者术后PCIA按压总次数以及有效次数差异无统计学意义（P>0.05）。A、B、C三组的不良反应分别为5例、1例和8例，A组与C组发生的例数较多，但三组间差异没有统计学意义。患者满意度上，B组满意率明显高于A组、C组，差异有统计学意义（P<0.05）。结论 应用舒芬太尼（0.04μg?kg-1?h-1）联合中剂量右美托咪定（0.08μg?kg-1?h-1）进行肺癌根治术后静脉自控镇痛，能产生良好的镇痛、镇静作用，且能够减少相关不良反应发生率，提高患者术后满意度。

关键词: 右美托咪定, 镇痛, 病人控制 , 肺癌, 舒芬太尼